Delegate Delaney Continues Support for Medicaid Expansion

Confidence is high among Democratic legislators in Fairfax County’s General Assembly delegation that nearly 400,000 more Virginians will be eligible for Medicaid coverage when the state adopts a budget, which must happen by July 1 to avoid a government shutdown.

The House of Delegates passed a $115 billion, two-year spending plan that included Medicaid expansion on Apr. 17 during a special session by a 67 to 33 vote.

Budget discussions have now shifted to the state Senate, which, unlike the House, did not include Medicaid expansion in its proposed budget from the 2018 regular session.

The two chambers introduced drastically different versions of the 2018-2020 biennium state budget during the General Assembly’s regular session but failed to reconcile them before the session ended on Mar. 10. Gov. Ralph Northam then called for a special session that convened starting Apr. 11.

Though the Senate has long resisted the idea of accepting federal money to bolster Virginia’s Medicaid program, which provides healthcare coverage to certain low-income residents, several Fairfax County state representatives all but guaranteed during a legislative wrap-up forum on Apr. 21 that an expansion will be included in the final budget.

“It’s all in the details now, but I do think we have the numbers,” Del. Mark Sickles (D-43rd) said during the Social Action Linking Together Richmond Legislative Wrap-Up forum at Virginia International University in Fairfax, echoing the optimism expressed by state Sen. Richard Saslaw (D-35th) at the start of the event.

The Virginia Senate Finance Committee was originally scheduled to discuss an overview of the differences between the House and Senate budgets on Apr. 18, but that meeting was canceled, and the committee’s online schedule does not list any upcoming meetings or hearings.

According to the Richmond Times-Dispatch, the Virginia Senate will not return to Richmond until May 14 and has yet to refer the budget bills approved by the House to its finance committee for consideration, a delay caused by Senate Republican leaders opposed to Medicaid expansion who say they want to see a report on the state’s revenue outlook first.

However, several prominent Republicans have changed their stance on Medicaid expansion after years of staunch opposition, making its inclusion in the final state budget increasingly likely.

Senate finance committee co-chair Emmett Hanger (R-24th) announced in an interview on Apr. 5 that he will not vote for a final budget “that doesn’t include accessing the additional federal money,” and state Sen. Frank Wagner (R-7th) wrote a column expressing support for expansion, the Richmond Times-Dispatch reported on Apr. 6.

State Sen. George Barker says the joint conference committee set up by the General Assembly to discuss the budget is on the verge of approving Medicaid expansion.

“We are going to get Medicaid expansion, no question about that,” Barker said. “In fact, we have a majority of the Senate conferees, not even counting me, who are in support of it, so we already have the votes on the conference committee to get it done.”

Virginia Democrats have made expanding Medicaid a core part of their legislative agenda since the option became available with the passage of the Affordable Care Act in March 2010.

The ACA initially intended to set a nationwide standard that would make anyone with an income up to 138 percent of the federal poverty level eligible for Medicaid, but the Supreme Court ruled in 2012 that participation in the expanded version of the program must be determined by each individual state.

33 states and Washington, D.C., have adopted Medicaid expansion as of Apr. 5, with all but eight of them making the change when it first became effective on Jan. 1, 2014, according to the Henry J. Kaiser Family Foundation.

If Virginia expands Medicaid, adults without children would become eligible for the program for the first time. The annual income ceiling would increase from $6,900 to $28,700 for parents in a family of three and from $9,700 to $16,750 for people with disabilities, according to Virginia’s Department of Medical Assistance Services.

The Commonwealth has lost about $10 billion in federal money from not expanding Medicaid, Saslaw says.

Under the ACA, the federal government covered the total cost of Medicaid expansion for states that adopted it in the first three years, though that has now been phased down to 90 percent of the cost.

Former Gov. Terry McAuliffe (D) attempted to pass Medicaid expansion in all four years of his term but never mustered enough support from a General Assembly overwhelmingly controlled by Republicans.

Fairfax County’s delegation credits the 2017 general election in November with turning the tide in the House of Delegates, where Democrats gained 15 seats to reduce the Republican 66-to-34 majority to a more even 51-49 split.

“This election in particular really was a referendum on healthcare,” Del. Karrie Delaney (D-67th), who was one of 19 incoming freshmen, said. “So many of us ran with that as a key component of our campaign that a lot of folks had the opportunity to give a second thought to that and realize this is something my constituents want.”

An early exit poll by NBC News from the Nov. 7 election showed healthcare was the top issue for Virginia voters, 37 percent of who chose that as their most important issue over gun policy, immigration, taxes, and abortion.

A poll conducted by the Republican-leaning research firm Public Opinion Strategies and released on Jan. 16 found that 83 percent of Virginians support expanding Medicaid, including about 72 percent of Republicans and drawing more than 80 percent favorability in all areas of the state, according to The Virginian-Pilot.

According to Barker, the evidence of broad public support for Medicaid expansion helped ease the fears of many Republicans that voting for it could cost them in their next primary election.

“What it really boiled down to was a legitimate concern that, if they voted for it, when they came up for reelection, they weren’t going to be beaten by a Democrat, but they did risk that some Republican would run against them in the primary and use that issue to unseat them,” Barker said.

While Medicaid expansion dominated much of the SALT forum, several legislators said that the wave of new delegates in the House led to progress on other issues as well.

The House passed a bill raising the state’s felony larceny threshold from $200 to $500 during the 2018 regular session. The State Senate had already passed the legislation in 2017, and Gov. Ralph Northam signed it into law on Apr. 4.

A bill introduced by Del. Patrick Hope (D-47th) that guaranteed the use of electronic visitation systems in state correctional facilities would not be used to prohibit in-person visitation passed the House and Senate unanimously, as did a bill requiring local school boards to adopt policies prohibiting school employees from punishing students who cannot pay for a meal by assigning them chores or making them wear a wristband or hand stamp.

The General Assembly continues to work on a bill that currently provides $154 million annually to a dedicated fund for Metro.

Legislators originally developed the deal on Metro in March during the regular session, but Northam included amendments to the bill when he returned it to the House for consideration during a reconvened session on Apr. 18.

The governor’s proposed amendments included a 1 percent tax increase on hotel stays in Northern Virginia and a real estate transfer tax increase from 15 cents to 20 centers per $100 of assessed value.

The tax increases targeted Northern Virginia, because it contains the jurisdictions served by Metro, and without them, the Northern Virginia Transportation Authority would have to divert money to Metro that it would otherwise have used on other transportation projects in the region.

The Senate supported the tax increases, but opponents in the House led by Del. Tim Hugo (R-40th) prevented the chamber from voting on the proposed amendment.

“Quite frankly, it was disgraceful,” Saslaw, who introduced the mass transit bill in the Senate, said of House Republicans opposing the tax increases. “…It’s taken $30 million that we were going to put back in NVTA for road construction, a lot of it in Hugo’s district that we now won’t have.”

The more sizable Democratic presence in the House did little to move the needle on gun safety, immigration, and other key issues, in part because the composition of many committees still favors Republicans, according to Del. Jennifer Boysko (D-86th).

Boysko’s Whole Woman’s Health Act, which aimed to remove several existing limits on abortion access, died in the House’s courts of justice committee.

A bill led by Del. Alfonso Lopez (D-49th) that would have given in-state tuition eligibility to undocumented students who have applied for permanent residency or are covered by deferred action programs similarly was left in the House committee on rules.

Virginia legislators introduced more than 70 gun-related bills in the 2018 regular session. Sen. Creigh Deeds’s (D-25th) legislation restricting access to firearms for minors ordered to involuntary mental health treatment was the only one enacted into law.

Speaker of the House Del. Kirkland Cox (R-66th) created a Select Committee on School Safety, the first such committee in more than 150 years, in the wake of the Feb. 14 mass shooting at Marjory Stoneman Douglas High School in Parkland, Fla.

The committee was directed to limit its scope to a series of specified issues, including security infrastructure and personnel, and behavioral health resources for students. Guns were not included on that list.

A General Assembly gun violence prevention caucus led by Del. Kathleen Murphy (D-34th) and Sen. Adam Ebbin (D-30th) announced the formation of a Safe Virginia Initiative task force on Apr. 3 will spend the legislative off-season discussing gun control and school safety measures with constituents around the state.

According to the Richmond Times-Dispatch, the task force will be chaired by Murphy and Del. Eileen Filler-Corn (D-41st).

“A lot of the gun safety policies have bipartisan support already in Virginia,” Del. Kathy Tran (D-42nd), who is part of the gun violence prevention caucus, said. “We just have to make sure we’re lifting up that voice.”